Sertac Yetiser

Expression of Epidermal Growth Factor, Tumor Necrosis Factor-α, and Interleukin-1α in Chronic Otitis Media with or without Cholesteatoma

Objective The object of this study was to compare the expression of epidermal growth factor, interleukin-1&agr;, and tumor necrosis factor-&agr; in chronic otitis media with or without cholesteatoma. Background It has been reported that cytokines and epidermal growth factor are effective in the bone resorption process in chronic otitis media. Bone resorption can also occur in chronic otitis media without cholesteatoma. However, comparative analysis is lacking. This issue has been investigated in a blind, controlled and prospective analysis. Method The activities of interleukin-1&agr;, tumor necrosis factor-&agr;, and epidermal growth factor were determined by commercially available enzyme-linked immunosorbent assay kits in tissue biopsy samples from 16 patients without cholesteatoma and from 23 patients with cholesteatoma (cholesteatoma epithelium). To establish a control group, external auditory canal skin was randomly collected from two groups (21 patients). The Mann-Whitney and Kruskal-Wallis tests were used for statistical analysis. Results The levels of interleukin-1&agr;, tumor necrosis factor-&agr;, and epidermal growth factor in tissue samples from the group with cholesteatoma were significantly greater than those in the group without cholesteatoma and the control group. No correlation was observed with other clinical factors such as age, sex, and antibiotic coverage. Conclusion Higher levels of cytokines in patients with cholesteatoma confirm that the destructive behavior of cholesteatoma is likely mediated by cytokines and epidermal growth factor and is the result of keratinocyte activity. Antibiotic treatment does not affect the level of cytokine concentration in patients with chronic otitis media and cholesteatoma, although the ear discharge subsides and inflammation-related symptoms regress in some cases.

Hypoglossal-facial nerve anastomosis: a meta-analytic study.

Objectives: A meta-analysis was conducted on the outcome of facial nerve function after hypoglossal-facial nerve anastomosis in humans. The roles of the timing of and the underlying cause for surgery, the type of the repair, and previous facial nerve function in the final result were analyzed. Methods: Articles were identified by means of a PubMed search using the key words “facial-hypoglossal anastomosis,” which yielded 109 articles. The data were pooled from existing literature written in English or French. Twenty-three articles were included in the study after we excluded those that were technical reports, those describing anastomosis to cranial nerves other than the hypoglossal, and those that were experimental animal studies. Articles that reported facial nerve function after surgery and timing of repair were included. Facial nerve function had to be reported according to the House-Brackmann scale. If there was more than 1 article by the same author(s), only the most recent article and those that did not overlap and that matched the above criteria were accepted. The main parameter of interest was the rate of functional recovery of the facial nerve after anastomosis. This parameter was compared among all groups with Pearsons X2 test in the SPSS program for Windows. Statistical significance was set at a p level of less than .05. Results: Analysis of the reports indicates that early repair, before 12 months, provides a better outcome. The severity of facial nerve paralysis does not have a negative effect on prognosis. Gunshot wounds and facial neuroma are the worst conditions for favorable facial nerve recovery after anastomosis. Transection of the hypoglossal nerve inevitably results in ipsilateral tongue paralysis and atrophy. Modification of the anastomosis technique seems to resolve this problem. Nevertheless, the effect of modified techniques on facial reanimation is still unclear, because the facial nerve function results were lacking in these reports. Conclusions: Hypoglossal-facial nerve anastomosis is an effective and reliable technique that gives consistent and satisfying results.

Facial nerve paralysis due to chronic otitis media.

Objective To present the characteristics of facial paralysis caused by chronic otitis media. The role of cholesteatoma, bony dehiscence, the duration of the disease, and the results of surgical therapy in facial paralysis were reviewed. Study Design Retrospective case review. Setting Tertiary care referral center. Patients A total of 24 patients (6 women, 18 men; age range, 17–74 yr) with facial paralysis were included in the study. Intervention Canal wall down mastoidectomy was performed in 14 patients (58.3%), modified radical mastoidectomy was performed in seven patients (25%), and intact canal wall mastoidectomy was performed in three patients (16.7%). All patients had decompression of the fallopian canal from the geniculate ganglion to the stylomastoid foramen without opening the epineural sheath. Results Eighteen patients (75%) had gradual onset of facial paralysis. The most common associated symptom with facial paralysis was vertigo in six patients. Twelve patients (50%) had no associated symptoms. Facial paralysis was the sole complication in 21 patients (87.9%). Three patients had multiple complications. Labyrinthitis was the most common associated complication. Facial paralysis was associated with congenital cholesteatoma in one patient. Fourteen patients (58.3%) demonstrated dramatic recovery within 3 months after surgery. Intraoperatively, cholesteatomas were found in 17 of the patients (70.8%). The fallopian canal was intact in four patients (none of them had a cholesteatoma), and 20 patients had bone destruction or dehiscence (three patients had no cholesteatoma). The tympanic segment was the most common site of involvement in 14 patients (58.3%). Conclusion A middle ear cholesteatoma was present in the majority of patients with facial paralysis caused by chronic otitis media. Gradual onset of facial paralysis was the most frequent pattern. Facial paralysis presented poor prognosis regardless of the presence of a cholesteatoma. There was no statistical difference among the results of surgical techniques.

Elongated styloid process: diagnostic problems related to symptomatology.

A certain number of patients with elongated styloid process may not have the classic cervicofacial complaints which were originally described by W. Eagle in 1937. Some of those cases who have radiologic evidence of elongated styloid process are symptom free and can be accepted as normal anatomical variants. On the other hand, some of those symptomatic cases may present uncommon neurologic signs and can be misdiagnosed as neurologic or infectious disease. Sometimes, the radiologic presence of an elongated process may cause the clinician to miss another pathology. Therefore, it is essential for the clinician to be aware of the clinical variants with different symptomatology or to particularly seek the origin of the pain in the head and neck before reaching a conclusion, since the only effective treatment in symptomatic cases is the surgical shortening of the process. We report five patients with elongated processes. Problems related to an elongated styloid process with different symptomatology are discussed and the associated literature is reviewed.

Impact of Tumor Size on Hearing Outcome and Facial Function with the Middle Fossa Approach for Acoustic Neuroma: a Meta-analytic Study

Objective--The purpose of this study was to review the English language literature concerning the effect of tumor size on hearing outcome and facial function after the middle fossa approach for acoustic neuroma in a large patient population. Material and Methods--The literature search identified a total of 11 studies reporting hearing outcome and facial function for a given tumor size. There were 1073 and 797 cases available for the analysis of hearing outcome and facial function, respectively. These cases were subdivided based on the way in which tumor size was measured: category 1 considered only the extracanalicular portion of the tumor; and category 2 considered the largest diameter of the tumor. In category 1, hearing and facial results were regrouped based on tumor size as follows: intracanalicular (IC) tumors; 1-9 mm tumors; 10-20 mm tumors; and a combined group of < 0.5 mm tumors, including IC tumors. In category 2, tumors were subdivided into 2 groups: those < 10 mm in diameter; and those 10-20 mm in diameter. In each category, tumor size groups were compared using the χ2 test in terms of the rate of functional hearing preservation and good facial function. Results--In category 1, analysis of the rate of functional hearing preservation showed that IC tumors compared favorably with the 1-9 mm and 10-19 mm tumors (56.9% vs 45.6%, p = 0.016; and 56.9% vs 32.3%, p < 0.001, respectively). The IC tumor group had the best rate of good facial function, followed by the 1-9 mm and 10-19 mm tumors (98.9% vs 93.9%, p = 0.007: and 98.9% vs 85.6%, p < 0.001, respectively). In category 2, rates of functional hearing preservation and good facial function were almost the same for tumors < 10 mm in diameter and those 10-20 mm in diameter (p > 0.05). Conclusion--The meta-analysis revealed that tumor size is an important variable determining hearing outcome and facial function. Inclusion of the IC portion of a tumor in the tumor size measurement apparently hampered the statistical power of the study, leading to an overestimation of the size of IC tumors.

The role of zinc in management of tinnitus

OBJECTIVE Several therapeutic modalities have been tried in patients with tinnitus. These trials have given rise to unsatisfactory results in most of the patients since the etiology and pathophysiology of tinnitus is unclear. Significant correlation between tinnitus and decreased zinc level and also reduction in severity of tinnitus after zinc therapy has been reported in some clinical studies. The aim of this study is to find out the prevalence of hypozincemia in patients suffering from tinnitus of various origins (presbyacusis, acoustic trauma and ototoxicity) at young and elderly population and to investigate the effect of zinc therapy upon the severity of tinnitus. METHODS Forty consecutive patients with severe tinnitus were included in this study between April 1998 and May 2000. There were 32 men (80%) and eight women (20%) with an age ranging between 19 and 67 (mean 40.6 years). Eleven patients were over the age of 50. The zinc level was measured in non-diluted serum by flame atomic absorption spectrophotometry (normal values; 50-120 microg/dl) from fasting blood samples. All the patients were given zinc pills 220 mg each, once a day and 2 h before lunch for 2 months. The patients were required to fulfill a tinnitus scoring scale and a handicap questionnaire before and after treatment. The Wilcoxon rank sum test and McNemar test were used for the statistical analysis. RESULTS Six patients were hypozincemic and seven patients had decreased serum zinc levels. No significant change has been observed in frequency and severity of tinnitus measured by audiologic tests after zinc therapy. Twenty-three (57.5%) of these patients reported some relief of tinnitus in the tinnitus scoring scale but the rate of improvement was minor (P>0.05). Decrease in severity of tinnitus after zinc therapy in elder group was better than the younger ones. CONCLUSION Our study could not confirm the high incidence of hypozincemia in patients with tinnitus as reported previously. Zinc therapy for 8 weeks presented no promising effect on tinnitus in three groups of patients and the difference between the rate of improvement in severity of tinnitus after zinc intake in patients with normal and low serum zinc level was not significant. Zinc supplement provided relief of tinnitus in some of the elder people who apparently had dietary zinc deficiency.

Vestibular Disturbance in Patients with Large Vestibular Aqueduct Syndrome (LVAS)

Large vestibular aqueduct syndrome (LVAS) is a common inner ear anomaly responsible for some unusual vestibular and audiological symptoms. The gross appearance of CT scan of the inner ear is generally normal. However, precise measurement of the inner ear components reveals abnormal dimensions, which may account for accompanying auditory or vestibular dysfunction. It has been reported that sudden increase in cerebrospinal fluid pressure can cause further deterioration of hearing due to transmission of pressure to the inner ear through the enlarged vestibular aqueduct. However, vestibular function is not often studied. In this report, audiovestibular function of 10 patients with large vestibular aqueducts was analysed and compared with the severity of the radiological deformity. The literature was reviewed and typical findings were discussed to emphasize varying aspects of audiovestibular function. It was found that some patients with LVAS have some spontaneous or provoked vestibular disturbance such as vertigo after watching revolving objects. The mean value of electronystagmographic abnormality in patients with hearing loss is greater than in patients with normal hearing. However, there is no statistical correlation between the level of hearing loss, electronystagmographic abnormality and severity of radiological deformity.

Magnetic resonance imaging of the intratemporal facial nerve in idiopathic peripheral facial palsy.

The aim of this study was to investigate the prevalence of facial nerve involvement with gadolinium-enhanced magnetic resonance imaging (Gd-MRI) in patients with idiopathic peripheral facial palsy (IPFP), and to discuss the localization and the pattern of enhancement. A total of 13 patients (9 female, 4 male) with IFPF were included in this study. Topographic tests and electromyography (EMG) were performed, and MRI was taken. Ten subjects whose cranial MRIs were taken for nonorganic pathology served as the control group. Twelve of 13 paralytic facial nerves had enhancement on postcontrast images. Two facial nerves of the control group demonstrated enhancement. We found a correlation between the enhancement of the facial nerve and the time for recovery. The average time from the onset of facial palsy to the recovery in patients with enhancement was 14 weeks, whereas it was 6 weeks in patient with no enhancement. Finally, all patients had complete recovery of the facial nerve function. We concluded that contrast enhancement of the paralytic facial nerve can be a radiological sign of a neural inflammation and may indicate a prolonged recovery.

Osteoma of the middle ear

Osteomas are benign pedunculated tumours of the lamellar bone, which commonly originates from paranasal sinuses. Within the temporal bone they are seen commonly in the external ear canal. Osteomas originating from the middle ear are very rare. There are only 12 cases reported in the medical literature up to now. Five of those cases caused conductive hearing loss and the others were asymptomatic and diagnosed incidentally.

Auditory brainstem evoked responses in insulin-dependent (ID) and non-insulin-dependent (NID) diabetic subjects with normal hearing

Hearing impairment has been reported to be one of the late complications of diabetes mellitus (DM), and the frequency varies. Previous data suggest that auditory brainstem potentials deteriorate long before the hearing impairment appears in patients with DM. Delay in neural conductance along the auditory pathway due to DM was assessed by means of auditory brainstem response (ABR) in 43 patients with normal hearing in a controlled study. Patients were classified according to age, presence of neuropathy, metabolic control, and duration and type of DM. ABR recordings revealed that absolute latencies of waves I, III and V were prolonged significantly in the diabetic group when compared to the control group ( p < 0.05). When two diabetic groups (insulin-dependent and non-insulin-dependent) were compared with each other, the difference between the latency of wave I and the inter-peak latencies of I–III, III–V and I–V was not significant ( p > 0.05). However, the difference between the latencies of waves III and V in the two diabetic groups was statistically significant. The duration of diabetes, blood glucose level and age were not associated with prolonged ABR latencies ( p > 0.05). Prolongation of latency of ABR in patients with DM should alert us to possible damage to the auditory nerve, and close follow-up is needed in these patients. Sumario Los trastornos auditivos han sido reportados como una de las complicaciones tardías de la diabetes mellitus (DM), y su frecuencia varía. Datos previos sugieren que los potenciales auditivos del tallo cerebral se deterioran mucho antes de la aparición del trastorno auditivo en pacientes con DM. Se evaluó el retardo en la conductancia neural, debido a la DM, a lo largo de la vía auditiva, por medio de respuesta auditivas del tallo cerebral (ABR) en un estudio controlado con 43 pacientes normooyentes. Los pacientes se clasificaron de acuerdo a la edad, a la presencia de neuropatía, al control metabólico y a la duración y al tipo de DM. Los registros del ABR revelaron que las latencias absolutas de las ondas I, III y V se prolongaron significativamente en el grupo de diabéticos, en comparación con el grupo control (p<0.05). Cuando se compararon entre sí dos grupos de diabéticos (dependientes de insulina y no dependientes de insulina) la diferencia entre las latencias de la onda I y las latencias inter-pico I-III, III-V y I-V no fue significativa (p>0.05). Sin embargo, la diferencia entre las latencias de las ondas III y V, en los dos grupos de diabéticos, fue estadísticamente significativa. La duración de la diabetes, los niveles de glucosa y la edad no parecieron estar asociados con una prolongación de las latencias en el ABR (p>0.05). La prolongación en las latencias en el ABR de pacientes con DM debe alertarnos sobre la posibilidad de daño en el nervio auditivo, y se requiere de un seguimiento riguroso de estos pacientes.